News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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News Flash 580

Weekly Snapshot of Public Health Challenges

Health and Financing  by Francisco Becerra-Posada 

Making IDA21 Work for Africa 

How Should the New Labour Government Rebuild Britain’s Approach to International Development?

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MeDevIS platform announced to boost access to medical technologies and devices

The effects of alcohol container labels on consumption behaviour, knowledge, and support for labelling: a systematic review

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South Africa Seeks to Alter Coal Pact Tied to $2.6 Billion

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IN A NUTSHELL
Author's note
…if steady financing were to be secured through laws, maybe the health sector in all countries could improve and thrive. Is not only having the funds, is how wisely ministries spend these. Is there proper planning? Are priorities set and a clear plan devised to achieve these?...

 By Francisco  Becerra-Posada, MD, MPH, DrPH

Health and Financing

One of the fields that has an impact on the lives of populations is public health. The actions of policies and programs that seek to improve the population, not in the field of the clinic in one-to-one interactions, but through collective actions together with social improvements, have a positive impact expressed in a decrease in morbidity and mortality rates.

The region of the Americas is, among the six regions of the World Health Organization, the ones that have shown the best progress in one of the actions that is perhaps the most equitable to provide children with an equitable start in life, vaccines. The WHO established the Expanded Program on Immunization and PAHO endorsed it in 1977, just 2 years after we began our studies.

It was the Pan American Health Organization, which last year celebrated its 120th anniversary, that made the fastest progress with the Expanded Program on Immunizations. The research and development of vaccines led to the availability of biologics against measles, rubella and mumps in the 1960s, and then with the production of the vaccine against chickenpox and inactivated Japanese encephalitis in the 1970s. By then, most of our generation had already been vaccinated against smallpox and almost certainly most of us suffered from “childhood” diseases, as we used to write in our medical records.

It was our children and now our grandchildren, who have benefited from the development of vaccines. What was a vaccination scheme of six biologicals, we now have a vaccination perspective for the life course, from birth to reaching older adults, and that we now benefit from these new vaccines for those over 60 years of age.

I had the opportunity and honor to be selected to serve as PAHO’s Assistant Director between 2013 and 2018. An interesting period for the region in terms of health. The elimination of rubella and measles was achieved, the proposal towards universal health coverage and access was launched (before the WHO did so), the PAHO Public Health Review was strengthened, among many other initiatives approved by the countries of the Region.

Advances in public health and health systems in countries have come a long way, and PAHO’s role is not equal in all countries. However, the COVID pandemic demonstrated the fragility of health systems around the world. PAHO is now renewing efforts with countries to strengthen primary health care and encourage health financing.

Health financing depends on many factors, political and social decisions and commitment. However, if steady financing were to be secured through laws, maybe the health sector in all countries could improve and thrive. Is not only having the funds, is how wisely ministries spend these. Is there proper planning? Are priorities set and a clear plan devised to achieve these?

Having secure funding, would protect immunization programs, there must be financial space for incorporation of novel vaccines, and to save towards an emergency vaccine fund as a preparedness measure for when the next pandemic reaches us. We have to learn from the COVID-19 experience and the resources needed for vaccines and medical care that had to be taken from other programs to face the emergency.

Sadly, few governments have a limited vision, and rather than thinking on state policies and decisions, they are motivated by priorities set by the government in charge that sadly, are limited in time. Have we learned something from the pandemic? Will ministries continue to move as usual? Hopefully, we will see a change. Are you going to contribute to it?

By the same Author on PEAH

Immunization Programs and Health Services

Apropos of COVID-19: Shall We Question Ourselves?

Implications of Covid-19 Pandemic on Health Systems

Have Countries Forgotten about the Sustainable Development Goals? The Case of the Americas

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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WHO releases first-ever clinical treatment guideline for tobacco cessation in adults

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IN A NUTSHELL
Editor's note Under One Health perspective, a live PDF here PEAH just received from our acknowledged partner Dr. George Lueddeke.
 
Originally from Canada, now residing in the United Kingdom, George Lueddeke PhD MEd Dipl.AVES (Hon.) is an education advisor in Higher, Medical and One Health education and global lead of the International One Health for One Planet Education initiative (1 HOPE) in association with national, regional, and global organisations

By George Lueddeke, PhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Re-Orientation to Sustain Life on Earth

A PDF by George Lueddeke

Just received from Dr. George Lueddeke, PEAH is  glad to bring to the attention of  its readership a live PDF poster  full of  hyperlinks aimed, under One Health perspective, at re-orienting practices and behaviours by governments, corporations and civil society for the sake of a sustainable living on Earth.

In this connection, excerpts from what already published by Lueddeke  can believably serve as an appropriate introduction:

...After billions of years of evolution, in just a few decades we have come to an inevitable turning-point. While we have made significant scientific / technological progress, we have failed to safeguard life on the planet including ours (we are but one of about 8.5 million species!). Although we have cognitive and affective capacities for achieving a harmonious world, our lives continue to be overridden by the self-interests, ambitions, and power of a few (1%?) -think  AI and technology! 

In the longer run, it appears that “a more just, sustainable and peaceful world” can only be achieved if we all realise the consequences of our short-term thinking (e.g., profits over survival, control or enslavement over freedoms) and learn to rise above the human-fabricated divisions and inequities that divide us (social, political, religious, economic, etc.). If we fail, so will future generations and humanity. Democratic societies depend on a shared belief in ‘something greater than themselves’ and holding ‘power to account’. 

https://www.peah.it/2022/05/11063/

...Whether we are able to achieve a “more just, sustainable and peaceful world” will depend on the decisions we make now as opportunities for social transformation are becoming increasingly time- limited. There is no question that new thinking is required and that both education and research are key in moving societies in new directions to ensure planet sustainability.  To these ends, here are a few re-orientations to consider by governments, corporations and civil society in general to sustain life on the planet shifting from:

human-centrism to eco-centrism;

subject fragmentation to disciplinary integration;

knowledge transfer to knowledge discovery;

intervention to prevention and a future consciousness;

individualism to ‘learning from and with others’:

those who ‘have‘ to those who ‘have not’;

thinking globally to acting locally;

profit margins to self-fulfilment and ‘doing something good’;

self-interests, ambition, power to understanding, compassion and  truth. 

https://www.peah.it/2022/05/11063/

Enclosed below is a link to an updated capacity-building publications poster (case study) originally prepared for UN SDG acceleration Summit last year

By George Lueddeke on PEAH

Betting on SDGs in a Disequal World

Holistic Systemic Change to Care for All Life on Earth

Earth Future: Time for a Global ‘Reset’!

Reflections on Transforming Higher Education for the 21st Century: PART 3 The international One Health for One Planet Education Initiative (1 HOPE) and the ‘Ecological University’

Reflections on Transforming Higher Education for the 21st Century: PART 2 Development of a Global ‘All Life’ Narrative

Reflections on Transforming Higher Education for the 21st Century: PART 1 The One Health & Wellbeing Concept

Planet Earth: Averting ‘A Point Of No Return’?

Tackling the Root Causes of Climate Change. If Not Now, WHEN?

Commentary on ‘More for The World Organisation for Animal Health (OIE) – Impakter’

Rebuilding Trust and Compassion in a Covid-19 World

The University in the early Decades of the Third Millennium: Saving the World from itself?

The World at Risk: Covid-19, Global Sustainability and 1 HOPE

Postscript – The World at Risk: Covid-19, Global Sustainability and 1 HOPE

 On this theme, see also

INTERVIEW – ‘Survival: One Health, One Planet, One Future’ – Routledge, 1st edition, 2019

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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SECURING OUR TB FREE FUTURE – EASTERN EUROPEAN AND CENTRAL ASIAN HEALTH LEADERS INCREASE POLITICAL COMMITMENT TO ENDING TUBERCULOSIS

Time for $5 campaign: Open letter to Danaher employees

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Gavi Includes Ebola, Meningitis, Rabies and Hepatitis B Vaccines in its Portfolio

Team Europe announces over €750 million to the African Vaccines Manufacturing

Assessing MEPs’ commitment to sustainable food systems: EU Food Policy Coalition’s scorecards unveiled

Creating Aspirations in Aspiration District Yadgir, a Pre-Industrial Pocket of India  by Veena S Rao

Women Warriors Winning Fight to Bring Back Indigenous Food Traditions

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It Will Take More Than Money to Close Africa’s Roads Gap: The Case for Investing in New Materials

Making Plastic Polluters Pay: How Cities and States Can Recoup the Rising Costs of Plastic Pollution (June 2024)

Nyéléni Process: Challenging the financing behind green and blue grabbing

IN A NUTSHELL
Author's note
...We are implementing a unique project to address malnutrition and provide rural livelihoods in Yadgir District, Karnataka, supported by the Department of Science and Technology, Govt. of India in partnership with Karnataka State Council for Science and Technology (KSCST) and Centre for Sustainable Technology (CST), Indian Institute of Science, Bangalore. Bharatiya Agro Industries Foundation (BAIF) Development Research Foundation are our field partners. Project details and progress are available at our website https://publicnutrition.aurosociety.org/

A valuable lesson that we have learnt so far in our journey for bringing about the much required behaviour change and belief systems change in the community and family is that children are the most aspirational and influential agents to create that change...

By  Ms. Veena S Rao, IAS (Retd)

Director,  Auro Centre for Public Nutrition, Public Health and Public Policy 

Bangalore, India 

Creating Aspirations in Aspiration District Yadgir, a Pre-Industrial Pocket of India

 General Background

The Government of India in 2018 initiated the Aspirational Districts Programme with the aim to transform 112 most under-developed districts of the country, quickly and effectively. The broad contours of the programme are convergence of State and Central programmes, collaboration of Central, State and District administrators, and competition among the districts through monthly delta ranking, all driven by a mass movement. The ranking is based on the incremental progress made across 49 Key Performance Indicators (KPIs) under 5 broad socio-economic themes – Health & Nutrition, Education, Agriculture & Water Resources, Financial Inclusion & Skill Development and Infrastructure.[1]

One such Aspiration District is Yadgir District in the state of Karnataka which is also the most backward district of the State. The policy of the Auro Centre for Public Nutrition, Public Health and Public Policy (ACPN) a vertical of Sri Aurobindo Society (SAS) Pondicherry, is to work in the most backward regions of the country.

We are implementing a unique project, “Establishing SHG/FPO[2] enterprises to address malnutrition and provide rural livelihoods in Yadgir District, Karnataka”, supported by the Department of Science and Technology, Govt. of India in partnership with Karnataka State Council for Science and Technology (KSCST) and Centre for Sustainable Technology (CST), Indian Institute of Science, Bangalore. Bharatiya Agro Industries Foundation (BAIF) Development Research Foundation are our field partners. Project details and progress are available at our website https://publicnutrition.aurosociety.org/

This is a unique, holistic, multi-sectoral, development project covering Horticulture, Women’s Empowerment, Nutrition and Education. Our project began in 2022 with a Base Line Survey of the two poorest quintile households of the District, and was accompanied by a multi-layered communication strategy for behavior change at community level.[3]

I am placing below an extract which tells us just how poor and worrisome the human development indicators of Yadgir District are.

• 20% of mothers of children below 3 years (all migrant labourers) said that their infants did not consume any complementary food until they were about 2 years. The mothers said that whenever the infants were given something from the family food, mostly roti, dal, idli (a soft steamed cake made from rice and lentils) or ganji (soft boiled rice), they were not able to digest it and became ill. All the mothers were migrant workers and did not access any benefits from ICDS (Integrated Child Development Services).
• Among children aged 6-35 years, about 64.5% are either stunted, or wasted or underweight. The proportion of children (both boys and girls) under 3 years who are not stunted, not wasted or not underweight decreases as the age increases, implying that their nutritional status/health deteriorates as they grow older.
• Among children aged 3-5 years about 72.79% are either stunted or wasted or underweight. The proportion of children (both boys and girls) who are not stunted, not wasted and not underweight decreases as age increases, implying that the nutritional status/health of the children is deteriorating as they grow older.
• About 17.5% of adolescent girls and 7.2% of the adolescent boys (between 11-18 years) are illiterate. None of the girls have studied up to class 10, and about 20% of boys are in class 10. Overall, about 47.39% adolescent girls and 52.9% adolescent boys are severely underweight and 27.96% girls and 30.77% boys are moderately underweight. About 57% of mothers of children under 3 years and 63.5% mothers of children between 3-5 years are illiterate. Consumption of fruits, vegetables, dairy products constitute a very small part of the daily diet.

The Table below shows some Baseline Survey Indicators compared with NFHS 5[4] Indicators for Karnataka State and Yadgir District

*Statistically Significant differences at 95% CI and p < 0.05

I have always maintained that one of the root causes for persistent undernutrition, anemia and calorie-protein-micronutrient deficiency among large sections of India’s population, especially the poorest 30-40 percent, is a complete vacuum in the market for low cost, fortified nutritious foods, which I call the market deficit.

The daily diets of the poorest families are meagre, subsistence diets and do not provide the balanced nutrition required for healthy growth of children and adolescents during rapid growth periods, for women during pregnancy and lactation, for all age groups of both genders during or after illness, and complementary food for infants after 6 months of age. Even though the per capita income has more than quadrupled in the last decade, the vast dietary deficit in terms of protein, calorie and micronutrients remains among around 50% of our population of both sexes and all age groups.^[5]

A Feasibility Study conducted through KPMG in 2018 under the World Bank funded Karnataka Multi-sectoral Nutrition Pilot Projects^[6] implemented by the Karnataka Comprehensive Nutrition Mission, gives a firm finding that there is a direct correlation between high incidence of low weight, stunting and wasting among children, low body mass index and stunting among adolescents, and lack of affordable fortified energy food in the market.  The study calculates a market demand of 42 million tons of low-cost energy food per year.

Data regarding severe child malnutrition and wasting on a real time basis in the Karnataka Multi-sectoral Nutrition Pilot Projects, led by the author, confirmed that all cases of severely malnourished/wasted children were from households where both parents were engaged in construction or agricultural labour. The infants were left under the care of elder siblings or grandparents, and apart from some roti (flat bread), rice and pulses, which the infants could not eat, there was no other food in the house. And there was no affordable, nutritive children’s food available in the market.

Availability of affordable, nutritious food in the market assumed even greater importance during the COVID 19 pandemic – lockdown and post lockdown. Reports from the field categorically informed that poor rural families were on a survival diet of rice and wheat given under PDS (Public Distribution System), and sometimes some dal. In many villages, even after the pandemic, there continued to be no milk or any other food for children. A study done by Azim Premji University confirmed this^[7].

On the other hand, India, one of the largest fruit and vegetable producers in the world loses a large percentage of production due to spoilage and post-harvest losses because of lack of primary processing facilities, fuel-efficient post-harvest technology and hygienic storage facilities. Horticultural loss estimates vary from 15% to 40%.[8] [9] In the absence of primary processing facilities for preservation or processing, it is to be expected that the wastage of horticulture produce will continue unless simpler methods using alternative source of energy and more decentralized operations at the grassroots for processing and preserving horticulture produce are introduced.

Our project therefore included that a Production Unit would be set up for producing fortified nutritious multi-grain food, VitaPoshan, for children, adolescents, adults and family, also using locally available horticulture produce with short shelf life, primarily tomatoes and bananas, through simple energy friendly rural technology.  Women SHGs would be trained for running the production unit with hand-holding support from us and for marketing VitaPoshan within the District. This would fill the huge technology gap that exists in Yadgir District, provide the poorest sections of the community access to affordable nutritious food, and prevent wastage of horticultural produce.

I am informed that our production unit will be the first medium scale production unit being set up in Yadgir District, though there are some small industrial units for cleaning pulses and cotton, the main agricultural crops of Yadgir District. In fact, I often describe Yadgir District as a “pre-industrial pocket of India”!

In short, the Project Objectives are: 

• Provide livelihoods to SHGs/FPOs through Innovative Farm Based Enterprises, Value Chains and Market Linkages.
• Address malnutrition, reduce anaemia and improve the health status of the community and provide fortified nutritious food to the rural poor – to children, adolescents, adults and family.
• Prevent wastage of fruits and vegetables, reduce losses during glut season, arrest distress sales and reduce market risks.
• Provide cash income to the SHGs/FPOs and contribute to their economic empowerment.
• Build capacity of FPOs/SHGs, improve the quality of life of women through value added income generation and marketing of nutritive horticultural products preserved/dehydrated/processed through fuel efficient, green energy. 

Project Interventions, Completed and Ongoing:

• Baseline Survey and Socio-Economic survey have been completed (2022). ^[10] The indicators are extremely worrisome and need urgent interventions. (Summary above)

• SHG mobilization and Information Education Communication (IEC) Campaign for Behaviour Change is ongoing. Advocacy material is being given to the SHGs with personal counselling regarding proper child, adolescent and maternal care, and proper dietary practices within family budgets.

• Product Development, Nutrition Analysis and Shelf Life Tests have been completed for all the four VitaPoshan products.

• A green, environment friendly, Production Unit is being set up by KSCST and CST, for producing fortified nutritious food, VitaPoshan, for children, adolescents, adults and a special nutritious family food, which is a fortified blend of pulses and tomato powder. Trial Production is expected to start by end of June 2024 and regular production is expected to start in July 2024.

• Marketing of products produced by the SHG women, will be done through a hybrid Marketing Strategy involving marketing by SHGs, traditional retail and wholesale distribution networks, on-line sales. Marketing training of women SHGs is going on.

We eagerly await VitaPoshan to start reaching the community, and hope to see an improvement in the human development indicators of the poorest households of the community.

A valuable Lesson Learnt

A valuable lesson that we have learnt so far in our journey for bringing about the much required behaviour change and belief systems change in the community and family is that children are the most aspirational and influential agents to create that change. We saw for ourselves how they actually created aspirations in this Aspirational District.

Initially, we had started the behaviour change programme with tried and tested methods of engaging with the women SHG members and village influencers.  Awareness generation activities were organized in villages focusing on basic child, adolescent and maternal care, and proper nutritional practices within family budgets. However, we realized that we were not creating any impact. We debated amongst ourselves – perhaps this indifference was on account of lack of trust which the community seemed to show for any kind of behaviour change messaging; perhaps their cynicism within the culture of poverty was too strong to allow them to believe the messages. After all, they had lived in this subsistence state for generations and had come to accept it with a sense of fatalism.

After much discussion and brain storming with our field partners, we finally concluded that the most influential agents of change in this generational subsistence society were the children, as they held a very special place in the family. The boys are treated as assets to take care of their parents once they are old and unable to work, and the girls are considered as temporary inmates who would move away to their marital homes after some years.  We learnt that parents here generally are very indulgent towards their children.

We therefore took a decision that we would start the behaviour change programmes through students in the senior schools. Relevant themes that were urgently required to be disseminated were selected and age appropriate IEC material in the form of posters and films were developed.

The themes covered were:

1. Importance of balanced diet and consumption of locally available fruits and vegetables
2. Not coming to school on an empty stomach
3. Avoiding junk food
4. Importance of clean drinking water and sanitation
5. Causes of anemia and how to prevent it
6. Intergeneration lifecycle of Malnutrition

IEC programmes were conducted in 40 senior schools across the district from November, 2022 onwards. The programmes were made more interesting through films[11], quizzes and games so that children could enjoy them and take home the messages to their parents. We deliberately selected schools in the most backward and remote villages of the district, many of which did not even have motorable roads.

Impact of Our Programme

An Impact Assessment was conducted in April 2023, across 40 schools in 37 villages, that covered formal interviews with students, parents and teachers.[12] The observations were extremely encouraging.

• There were positive behaviour changes in around 60% families
• Many students started eating sprouts and local fruits daily
• All children started eating a meal before coming to school
• Children started asking their parents for a variety of fruits and vegetables
• Students realised the risks of junk food and chose healthier options like chikki (peanut and jiggery toffee) and banana as a snack
• Students were not wasting vegetables served as part of their school mid-day meal
• Teachers reported that the health of students who followed the messages has improved
• Students were more active; they participated in games and had better concentration in the classroom

We were extremely happy that our experiment of starting behavior change and creating aspirations in the family through children worked. I hope this important learning will be useful for other development agencies, NGOs, and field workers operating in the poorest regions of the world.

References

[1] https://www.niti.gov.in/aspirational-districts-programme

[2] SHG- Self Help Group; FPO-Farmer Producer Organization

[3] https://publicnutrition.aurosociety.org/wp-content/uploads/2023/03/Baseline-and-Social-Survey-Yadgir.pdf

[4] National Family Health Survey 5, 2019-2020

[5] NFHS 5, 2019-20; Comprehensive National Nutrition Survey 2016-18; NNMB 3rd Repeat Survey (2012; NNMB Report 27, 2017

[6]http://karnutmission.org.in/documents/New_Feasibility_Study.pdf

[7]https://cse.azimpremjiuniversity.edu.in/wp-content/uploads/2020/06/Compilation-of-findings-APU-COVID-19-Livelihoods-Survey_Final.pdf

[8]https://www.researchgate.net/publication/374116896_Post_harvest_losses_of_fruits_and_vegetables_in_India

[9] https://www.nationalheraldindia.com/national/40-vegetables-fruits-get-wasted-in-india-iari-director#google_vignette

[10] https://publicnutrition.aurosociety.org/wp-content/uploads/2023/03/Baseline-and-Social-Survey-Yadgir.pdf

[11] The films can be viewed @ https://publicnutrition .aurosociety.org/gallery/

[12] : https://publicnutrition.aurosociety.org/wp-content/uploads/2023/04/27-4-Impact-Assessment.pdf

—

By the same Author on PEAH

Karnataka Multisectoral Nutrition Pilot Project (2014-2018): Some Significant New Evidence Based Findings and Need for Further Research

Multisectoral Nutrition Interventions: Impact and Transitions in Undernutrition, Stunting and Wasting in Children – An Open Experiment in Two Remote Blocks of Karnataka

Nourishing India – What Needs to Be Done

IN A NUTSHELL
Editor's note  Far-reaching reflections here PEAH just received from our acknowledged partner Dr. George Lueddeke. 

 Originally from Canada, now residing in the United Kingdom, George Lueddeke PhD MEd Dipl.AVES (Hon.) is an education advisor in Higher, Medical and One Health education and global lead of the International One Health for One Planet Education initiative (1 HOPE) in association with national, regional, and global organisations

By George Lueddeke, PhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Betting on SDGs in a Disequal World

Excerpts on SDGs shared with evolving regional 1 HOPE-TDR steering committee members (Africa, Americas, Asia, Europe) may be of interest to PEAH readership… trying to raise awareness of several important developments impacting on our collective futures:

G7 leaders at the Italy summit (13-15 June 2024).  Image Credit: International Institute for Sustainable Development (IISD) 

(1) “G7 Pledges to Accelerate SDGs, Transition from Fossil Fuels This Decade“

(2) UN Sustainable Development Goals

…The 2024 progress assessment reveals the world is severely off-track to achieve the 2030 Agenda. As illustrated in Figure 1, out of 135 targets with trend data and additional insights from custodian agencies, only 17% are progressing as expected to be achieved by 2030. Nearly half (48%) exhibit moderate to severe deviations from the desired trajectory, with 30% showing marginal progress and 18% indicating moderate progress. Alarmingly, 18% have stagnated, and 17% have regressed below the 2015 baseline levels…

(3) UN 2024 SDG progress report

Countries are ranked by their overall score. The overall score measures the total progress towards achieving all 17 SDGs. The score can be interpreted as a percentage of SDG achievement. A score of 100 indicates that all SDGs have been achieved.

(4)  Country Rankings

(5) 1 HOPE-TDR: “Cultivating an active care for the world and those with whom we share it” (UNESCO)

It is in Part 2 of the 2024 SDG Report and gives a clear picture - including progress- of where the world stands in relation to the SDGs and makes a case for 1 HOPE-TDR (e.g., #14,#15,#16)  and the urgency for all stakeholders - Government, Civil Society (e.g., academia),  Business..- to shift from human-centrism ('it's all about us') to Earth /eco-centrism ('it's about all life on the planet) and sustaining our 'blue' planet in a shared environment.

Importantly, the countries with the highest scores are all democracies (freedoms!).  Anyone who believes that living in an autocracy or neo-fascism is better must take a close look at North Korea today – along with recalling life under Nazi Germany.  The recent  article North Koreans face lives devoid of hope, UN rights chief says is a wake-up call for us all and clearly demonstrates that freedom of  choice  in all aspects of life is far better than  enslavement!  Indeed, the happiest countries in the world are those where freedom of the press is the greatest!

readers are invited to comment on the content and suggestions of this post   

—————————-

By George Lueddeke on PEAH

Holistic Systemic Change to Care for All Life on Earth

Earth Future: Time for a Global ‘Reset’! 

Reflections on Transforming Higher Education for the 21st Century: PART 3 The international One Health for One Planet Education Initiative (1 HOPE) and the ‘Ecological University’ 

Reflections on Transforming Higher Education for the 21st Century: PART 2 Development of a Global ‘All Life’ Narrative 

Reflections on Transforming Higher Education for the 21st Century: PART 1 The One Health & Wellbeing Concept 

Planet Earth: Averting ‘A Point Of No Return’? 

Tackling the Root Causes of Climate Change. If Not Now, WHEN?

Commentary on ‘More for The World Organisation for Animal Health (OIE) – Impakter’

Rebuilding Trust and Compassion in a Covid-19 World

The University in the early Decades of the Third Millennium: Saving the World from itself?

The World at Risk: Covid-19, Global Sustainability and 1 HOPE

Postscript – The World at Risk: Covid-19, Global Sustainability and 1 HOPE

 On this theme, see also

INTERVIEW – ‘Survival: One Health, One Planet, One Future’ – Routledge, 1st edition, 2019

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Smooth tubeworm (Protula tubularia)

News Flash 577

Weekly Snapshot of Public Health Challenges

Academic Sign-on: Call for the adoption of an additional Protocol to the European Convention on Human Rights on the right to a clean, healthy, and sustainable environment

Health not a priority in EU Council’s 2024-2029 strategic agenda

UNAIDS funding shortfall disrupts NGO work

People’s Health Dispatch Bulletin #78: Starvation looms over Gaza; commercialization threatens health in Brazil

Report: Number of internally displaced people in Haiti increases by 60% 

HRR 728: WHAT IS IMPORTANT IS WHICH SIDE OF THE SOCIAL STRUGGLE WE/YOU TAKE SO AS NOT TO APPEAR DEFENDING THE INTERESTS OF THE OVEREXPLOITING SOCIAL CLASS

UN reports ‘shocking’ rise in violations against children in conflict in 2023

Platform to transform African agriculture launches at Paris Peace Forum

Land Grabs Squeeze Rural Poor Worldwide

WHO releases report on state of development of antibacterials

Impact of the Pandemic on Health Inequalities: How COVID-19 Exacerbated Existing Disparities  by Nicolas Castillo

Is Africa Ready for the Next Pandemic?

World Is Not Ready for the Next Pandemic But Independent Panel Leaders Offer Way Forward

South Africa Records Two Deaths From MPox as More Cases Emerge

Chad eliminates human African trypanosomiasis as a public health problem

Danaher continues to charge exorbitant prices for lifesaving medical tests despite urgent demands for price reductions by several Ministries of Health

Opinion: Pharma profiteering isn’t going away, and so we can’t either

PAF v AbbVie excessive pricing case the Netherlands

Inadequate Access to Essential Medicines in Poor Countries  by Christiane Fischer 

WHO issues warning on falsified medicines used for diabetes treatment and weight loss 

Analysis of opioid analgesics consumption in Africa: a longitudinal study from a 20-year continental perspective

ARE YOU NOT ADDICTED TO CANNABIS? PROVE IT  by Nejat Hassen, Dr. Mohita Chadha, Dr. Michael Chaiton, Dr. Sumedha Kushwaha 

A new model of drug discovery could change the game on superbugs

Faster access to clinical trial information in Europe

WHO Issues First-Ever Set of Guidelines for Taxing Unhealthy Foods

Climate change funding talks stuck ahead of COP29 summit

Bangladesh Can Boost Growth & Climate Resilience by Investing in Women

EU Council supports ratification of UN agreement protecting oceans

Coastal carbon removal methods ‘oversold’ – study

A Healthier, Climate-Smart Way Forward for Transportation

Four in five people want more climate action: UN survey

IN A NUTSHELL
Authors's note
This article discusses about the Stop Cannabis Challenge app developed by The Centre for Addiction and Mental Health (CAMH) to support tolerance breaks and cannabis abstinence. This app promotes cannabis addiction awareness and provides cessation support through health education and intervention

Splash screen of the Stop Cannabis Challenge App

By 

Nejat Hassen(1), Dr. Mohita Chadha(2), Dr. Michael Chaiton(3), Dr. Sumedha Kushwaha(4)

1-Student, Healthcare Management Program, Longo Faculty of Business, Humber College

2-Chief Operating Officer, Global Initiative for Public Health and Innovation

3-Independent Scientist, Center for Addiction and Mental Health

4-Research Assistant, Center for Addiction and Mental Health

 Toronto, Ontario, Canada

ARE YOU NOT ADDICTED TO CANNABIS? PROVE IT

Canada is facing a serious mental health crisis alongside rising substance abuse and dangerous drug use. Substance abuse is influenced by many complex factors often beyond individual control (P. H. A. of Canada, 2021). The Cannabis Act, effective October 17, 2018, regulates access, production, distribution, and sale of cannabis. The 2023 Canadian Cannabis Survey reported an increase in cannabis use from 22% in 2018 to 26% in 2023 (H. Canada, 2021).

Cannabis contains two main components: THC and CBD (Zehra et al., 2018). While not everyone who uses cannabis becomes addicted, frequent and long-term use, especially starting in early adolescence, can lead to addiction. Cannabis Use Disorder (CUD) is defined as the inability to stop using cannabis despite it causing harm. About 10% of the 193 million global cannabis users are affected by CUD (Connor et al., 2021).

In 2016, about 22.1 million people worldwide met the criteria for CUD (The Global Burden of Disease Attributable to Alcohol and Drug Use, 2018). Problematic cannabis use includes behaviors like neglecting major duties, giving up important activities, using more cannabis than intended, and being unable to cut down on use. Withdrawal symptoms, both mental and physical, can occur when frequent users stop, increasing the risk of relapse (H. Canada, 2018b).

Treating CUD is complicated by other mental health and substance use disorders. Cognitive behavioral therapy, motivational enhancement therapy, and contingency management can reduce cannabis use, but long-term abstinence is rare (Connor et al., 2021). Legalizing non-medical cannabis could increase CUD by making potent cannabis more accessible and cheaper. Education on the risks and help-seeking is crucial.

Engaging young people with CUD is challenging, but digital interventions show promise. Technology can effectively reach many people, helping to prevent, screen, and treat CUD (Brezing & Levin, 2022). Mobile technology offers new ways to address substance use disorders, including cannabis cessation.

We developed the “Stop Cannabis Challenge” app with The Centre for Addiction and Mental Health (CAMH) to support tolerance breaks and cannabis abstinence. This app promotes cannabis addiction awareness and provides cessation support through health education and intervention.

App Description

• Abstinence Tracker: allows users to track the time since they last used cannabis. The time is displayed in days, hours and minutes. This serves as a motivational tool by visually representing their progress and encouraging longer periods of abstinence.
• Chatbot Enabled FAQ Section: a 24/7 chatbot offers users instant access to information on various topics related to cannabis use and cessation. This ensures users receive timely support and answers to their questions at any hour.
• Mood and Craving Tracker: records daily moods and cravings with graphical representations of their emotional and physical states. Analyzing this data on a weekly and monthly basis helps users identify patterns and triggers that may affect their cessation journey.
• Invite Friends: The app enables users to send invitations to both registered and non-registered users, fostering a supportive community. Users can view friend requests received and send out invitations, building a network of support crucial for successful cessation.
• Leaderboard: To offer positive reinforcement, the app includes a leaderboard that ranks users and their friends based on a complex algorithm. It motivates users to remain committed to their goals by seeing their progress with others.
• Challenge History and Badges: Users earn badges as they progress, categorized by hours, days, and weeks of abstinence. This provides reward milestones and summaries of current and previous challenges.
• Motivational Messages: Automated daily motivational messages are sent as in-app notifications to inspire users, offering encouragement and positive reinforcement throughout their cessation journey.
• Baseline Stop Cannabis Survey: The Cannabis Use Disorder Identification Test-Revised (CUDIT-R) has a set of 16 questions which are present to the newly registered user to assess cannabis dependence and its problematic use.
• Ecological Momentary Assessment (EMA): is presented each time the user stops the abstinence tracker. It aims to collect multiple responses around cannabis withdrawal, peer cannabis use, reasons for use, craving, location during cannabis use, and feedback of the user.

Can technology be used?

Research shows digital interventions can effectively reduce substance use. Several studies have found significant reductions in substance use behaviours through digital tools. For instance, a systematic review of digital interventions aimed at reducing substance misuse among students found significant reductions in substance use behaviours, emphasizing the positive impact on health, social, and economic problems (Dick et al., 2019). A specific randomized controlled trial focusing on an Internet-based intervention to reduce cannabis use (ICan) showed that participants in the intervention group experienced significant reductions in cannabis use compared to the control group, highlighting the potential of digital tools to aid in substance use reduction (Olthof et al., 2021).

Qualitative feedback from users of digital interventions often underscores their acceptability and usefulness. Users find these tools easy to use and appreciate the anonymity and accessibility they provide. Participants have reported positive experiences, including improved self-efficacy and overall quality of life (Jormand et al., 2022).

Conclusion

The Stop Cannabis Challenge app represents a valuable tool in the fight against cannabis addiction. By evaluating its feasibility and efficacy through studies and user feedback, we can improve the app and enhance public health outcomes in Canada. Engaging users through co-creation and integrated knowledge translation ensures the app meets their needs and maximizes its effectiveness. This app is a significant step forward in digital health interventions for cannabis cessation, offering a reliable, user-friendly tool to support individuals in their efforts to quit cannabis. A feasibility study will help refine the app and contribute to the broader field of substance use disorder treatment, ultimately improving public health.

References

Brezing, C. A., & Levin, F. R. (2022). Applications of technology in the assessment and treatment of cannabis use disorder. Frontiers in Psychiatry, 13, 1035345. https://doi.org/10.3389/fpsyt.2022.1035345

Canada, H. (2018a, March 2). Addiction to cannabis [Education and awareness]. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/addiction. html

Canada, H. (2018b, October 17). Is cannabis addictive? [Research;education and awareness]. https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/cannabis-addicti ve.html

Canada, H. (2021, December 16). Key findings: Cannabis use in Canada (2023) — Canada.ca [Datasets;statistics;education and awareness;interactive resource;]. https://health-infobase.canada.ca/cannabis/

Canada, P. H. A. of. (2021, December 15). Statement from the Minister of Mental Health and Addictions on the Overdose Crisis [Statements]. https://www.canada.ca/en/public-health/news/2021/12/statement-from-the-minister-of-mental-health-and-addictions-on-the-overdose-crisis.html

Connor, J. P., Stjepanović, D., Le Foll, B., Hoch, E., Budney, A. J., & Hall, W. D. (2021). Cannabis use and cannabis use Disorder. Nature Reviews. Disease Primers, 7(1), 16. https://doi.org/10.1038/s41572-021-00247-4

Dick, S., Whelan, E., Davoren, M. P., Dockray, S., Heavin, C., Linehan, C., & Byrne, M. (2019). A systematic review of the effectiveness of digital interventions for illicit substance misuse harm reduction in third-level students – BMC public health. BioMed Central. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7583-6

Elsbernd, A., Hjerming, M., Visler, C., Hjalgrim, L. L., Niemann, C. U., Boisen, K. A., Jakobsen, J., & Pappot, (2018). Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study. JMIR Formative Research, 2(2), e23. https://doi.org/10.2196/formative.9842

Government of Canada, C. I. of H. R. (2012, December 6). Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches – CIHR. https://cihr-irsc.gc.ca/e/45321.html

ICD-11 for Mortality and Morbidity Statistics. (n.d.). Retrieved February 28, 2024, from https://icd.who.int/browse/2024-01/mms/en

Jormand, H., Bashirian, S., Barati, M., Rezapur-Shahkolai, F., & Babamiri, M. (2022). Evaluation of a web-based randomized controlled trial educational intervention based on media literacy on preventing substance abuse among college students, applying the Integrated Social Marketing Approach: A study protocol – trials. BioMed Central. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-022-06913-6

Olthof, M. I. A., Blankers, M., Laar, M. W. van, & Goudriaan, A. E. (2021). ICAN, an internet-based intervention to reduce cannabis use: Study protocol for a randomized controlled trial – trials. BioMed Central. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-04962-3

Kroon, E., Kuhns, L., Hoch, E., & Cousijn, J. (2020). Heavy cannabis use, dependence and the brain: A clinical perspective. Addiction (Abingdon, England), 115(3), 559–572. https://doi.org/10.1111/add.14776

The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. (2018). The Lancet. Psychiatry, 5(12), 987–1012. https://doi.org/10.1016/S2215-0366(18)30337-7

Zehra, A., Burns, J., Liu, C. K., Manza, P., Wiers, C. E., Volkow, N. D., & Wang, G.-J. (2018). Cannabis Addiction and the Brain: A Review. Journal of Neuroimmune Pharmacology, 13(4), 438–452. https://doi.org/10.1007/s11481-018-9782-9

SCREENSHOTS

Homepage displaying Manage Challenge which allows users to track the time since they last used cannabis, My Progress which records daily moods and cravings with graphical representations of their emotional and physical states, Chat & FAQs, a 24/7 chatbot offers users information on various topics related to cannabis use and cessation

Chatbot Enabled FAQ Section: a 24/7 chatbot offers users instant access to information on various topics related to cannabis use and cessation. This ensures users receive timely support and answers to their questions at any hour

Mood and Craving Tracker records daily moods and cravings with graphical representations of their emotional and physical states. Analyzing this data on a weekly and monthly basis helps users identify patterns and triggers that may affect their cessation journey

Abstinence Tracker: allows users to track the time since they last used cannabis. The time is displayed in days, hours and minutes. This serves as a motivational tool by visually representing their progress and encouraging longer periods of abstinence

Challenge History and Badges: Users earn badges as they progress, categorized by hours, days, and weeks of abstinence. This provides reward milestones and summaries of current and previous challenges

IN A NUTSHELL
Author's note
Essential medicines are medicines that meet the health needs of the country's population and should always be available in sufficient quantities, in the appropriate dosage form and at an affordable price.

 The World Health Organization WHO has been compiling the model list[i] since 1977 and updating it every two years. Each country should adapt it to its needs. 

Access to essential medicines in Africa, Latin America and Asia is inadequate. Economic, political, infrastructural and social aspects mean that many people in these countries have no or only insufficient access to essential medicines

By Dr. med. Christiane Fischer

Chairwoman, PHM Deuteschland

Inadequate Access to Essential Medicines in Poor Countries

Challenges in accessing essential medicines

Patents

Patents are a major driver of high drug prices and a major obstacle to access in the global south. The minimum requirements for a product to qualify for a patent are: it must be new, manufacturable by industry and innovative. This is regulated by an agreement of the World Trade Organization (WTO), the Agreement on the Protection of Intellectual Property Rights (TRIPS). However, the agreement does not regulate when a product is considered innovative.

The World Trade Organization WTO has existed since 1994. Since then, there has been 20 years of patent protection on all products, including medicines. During this time, the company has a temporary monopoly. As with any monopoly, this leads to price increases and a shortage of supply. Patent protection applies in all WTO member states, although there are exceptions for the least developed countries (LDCs). Since January 1, 2005, developing countries that are not LDCs have had to implement the provisions of the TRIPS agreement and grant full product patent protection for medicines. This also includes India, the country with the largest pharmaceutical production in the world. Without India, almost all African countries would not be able to be supplied. In the case of vaccines or antiretroviral drugs (ARVs) that are effective against HIV, this means that many people in poor countries, especially in most African countries, do not have access to these drugs or do not have access to them in sufficient quantities. The problem also affects other drugs.

Many unnecessary patents are also granted in many African countries. Indian patent law, on the other hand, prohibits such patents on so-called marginal innovations. Therefore, many drugs can be exported from India but not imported into African countries.

In India there are also many local production capacities for drugs. They mostly produce generic drugs. India is also known as the pharmacy of the poor. In Africa, local production facilities exist almost exclusively in South Africa. Many countries in these regions have only limited capacity to produce drugs locally, which leads to a strong dependence on imported drugs. A transfer of technology and knowledge to develop local production is urgently needed.

Other reasons for high drug costs

Many countries in Africa, Latin America and Asia have limited financial resources and cannot purchase expensive essential medicines. This particularly affects patented medicines. But high prices on medicines also arise when there is only one manufacturer, creating a quasi-monopoly. These are then referred to as neglected medicines. High poverty rates in these regions are an additional factor and mean that many people cannot afford the medicines they need. Health insurance hardly exists and people have to finance most expenses out of their own pockets.

Some diseases, such as multiple sclerosis, are less common or less diagnosed in these countries. The prices of medicines that are supposed to work against these diseases are unrealistically high. Most people cannot afford the medicines. The World Health Organization (WHO) has included three MS drugs in its model list of essential medicines for the first time in 2023. But their effectiveness is limited. The critical organization LinienWatch, which checks guidelines for conflicts of interest, gives the guidelines published by the Society of Neurology only a mediocre rating, awarding them ten out of a possible 18 points.[ii]

The overpriced drugs also have very problematic side effects. Cladribine (a single 10 mg tablet costs €2,663) carries the risk of serious liver damage, as Merck Healthcare Germany admits in a Red Hand Letter.[iii] Glatiramer acetate (30 pre-filled syringes cost €1,426.96) can also lead to acute liver failure. And rituximab (in Germany you pay €1,085.70 for an infusion bottle) can lead to serious immune deficiencies, warns the Drug Commission of the German Medical Association.[iv]

Infrastructure problems

Infrastructure problems also exist in many poor countries. Unreliable supply chains can lead to bottlenecks and delays in the delivery of medicines. Lack of infrastructure for the safe storage and transport of medicines exists particularly in remote or rural areas. In villages there are often no refrigerators, so many medicines cannot be cooled and therefore cannot be used. This affects HIV medicines and vaccines, among others.[v]

Overly strict or inefficient regulatory processes and corruption also hinder access to new and important medicines. However, there is a risk that the argument will be misused by the pharmaceutical industry to justify why essential medicines do not reach those affected.

Lack of education, insufficient knowledge and problematic awareness about the correct use of medicines exist. They are often just an excuse to keep people away from essential medicines.

Strategies to improve access

There are many strategies in poor countries to improve access to essential medicines. These include strengthening health systems, improving the infrastructure for storing and transporting medicines, and developing efficient and transparent supply chains.

Providing financial assistance to poor population groups is essential to enable them to access essential medicines. A successful example is that in the Indian state of Tamil Nadu, essential medicines are made available to everyone free of charge in the public health sector.[vi]

A ban on patents on medicines would make medicines more affordable. On October 2, 2020, India and South Africa submitted a request to the World Trade Organization (WTO) to at least temporarily suspend patent protection for all products that are necessary for the prevention, containment and treatment of Covid-19. In WTO language, such an exception is called a “waiver”. This request failed mainly due to resistance from wealthy countries, including the USA, Great Britain and Germany.[vii]

Success stories and initiatives

International cooperation, local initiatives and innovative approaches are crucial to tackling the health challenges in these regions. Successful examples include:

Global Fund to Fight AIDS, Tuberculosis and Malaria: A financing instrument against major infections. The global fund provides the financial means to fight these diseases and has thus improved access to medicines in many affected countries. [viii]

Gavi, the Vaccine Alliance: Gavi has successfully improved access to life-saving vaccines in developing countries. Since its founding in 2000, Gavi has promoted the vaccination of 760 million children against life-threatening diseases such as diphtheria, tetanus and whooping cough, thus preventing around 13 million deaths. [ix]

The Medicines Patent Pool (MPP) is committed to improving the health of people in low- and middle-income countries. It is part of the United Nations. It improves access to high-quality, safe, effective, appropriate and affordable medicines, especially for the treatment of HIV/AIDS and tuberculosis. To do this, MPP negotiates with patent holders to put their intellectual property into the pool. MPP then grants licenses to facilitate the production of affordable generics.[x]

References

[i] WHO, WHO Model Lists of Essential Medicines, 2023

https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/essential-medicines-lists (10.6.2024)

[ii] https://www.leitlinienwatch.de/diagnose-und-therapie-der-multiplen-sklerose-neuromyelitis-optica-spectrum-erkrankungen-und-mog-igg-assoziierten-erkrankungen-2/ (10.6.2024)

[iii] Merck Healthcare Germany , Mavenclad ® (Cladribin-Tabletten): Risiko von schwerwiegendenn Leberschäden und neue Empfehlungen zur Überwachung der Leberfunktion, 16.02.2022 https://www.akdae.de/fileadmin/user_upload/akdae/Arzneimittelsicherheit/RHB/Archiv/2022/20220216.pdf (10.6.2024)

[iv] WHO endorses landmark public health decisions on Essential Medicines for Multiple Sclerosis, 2023
https://www.who.int/news/item/26-07-2023-who-endorses-landmark-public-health-decisions-on-essential-medicines-for-multiple-sclerosis (10.6.2024)

DMSG, WHO nahm drei MS-Medikamente in Liste der unentbehrlichen Arzneimittel auf, 2023
https://www.dmsg-berlin.de/aktuelles/detailansicht/who-nahm-drei-ms-medikamente-in-liste-der-unentbehrlichen-arzneimittel-auf-355 (10.6.2024)

U Rosien, Akutes Leberversagen unter Glatirameracetat, Arzneiverordnung in der Praxis 1/2016
https://www.akdae.de/arzneimitteltherapie/arzneiverordnung-in-der-praxis/ausgaben-archiv/ausgaben-ab-2015/ausgabe/artikel?tx_lnsissuearchive_articleshow%5Baction%5D=show&tx_lnsissuearchive_articleshow%5Barticle%5D=4431&tx_lnsissuearchive_articleshow%5Bcontroller%5D=Article&tx_lnsissuearchive_articleshow%5Bissue%5D=9&tx_lnsissuearchive_articleshow%5Byear%5D=2016&cHash=92b896421c776b703a6127464f5c4b68  (10.6.2024)

AKDÄ, Schwere Immundefekte nach Behandlung mit Rituximab
Deutsches Ärzteblatt, Jg. 115, Heft 49, 07.12.20
https://www.akdae.de/arzneimittelsicherheit/bekanntgaben/newsdetail/schwere-immundefekte- 2015nach-behandlung-mit-rituximab-aus-der-uaw-datenbank (10.6.2024)
The prices refer to the German Red List 2023

[v] MSF, Empty Shelves Come Back Tomorrow,

https://www.aerzte-ohne-grenzen.at/sites/default/files/attachments/empty_shelves_report_low.pdf (10.6.2024)

[vi] NHM. Free Drugs Service Initiative
 https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1218&lid=192 (10.6.2024)

[vii] Paritätischer Wohlfahrtsverband ,Paritätisches Positionspapier Patente für Covid-19 relevante medizinische Produkte und Technologien aussetzen, Menschen weltweit schützen” 2020
https://www.der-paritaetische.de/alle-meldungen/paritaetisches-positionspapier-zur-aussetzung-des-patentschutzes-fuer-imfpstoffe-gegen-das-corona-virus/ (10.6.2024)

[viii]https://www.theglobalfund.org/en/  (10.6.2024)

[ix] https://www.gavi.org/  (10.6.2024)

[x] https://medicinespatentpool.org/ (10.6.2024)

—

By the same author on PEAH

 Covid-19 and the Global South

 Access to Corona Vaccination only for the Rich

Action Alliance “Training 2020” – An Alliance for Independent Continuing Medical Education

Corrupt Medical Practices in Germany

Interview: MEZIS (Mein Essen zahl ich selbst – I pay for my own lunch)